General practice issues in Parliament – June 2022

On 21 June the Labour Party used their ‘Opposition Day’, an opportunity for non-government parties to choose debate topics, to raise the issue of ‘Access to GP Services and NHS Dentistry’. The sessions can be watched here.

Wes Streeting, the shadow Secretary of State for Health and Social Care and Ilford North MP, affirmed that ‘primary care is in crisis’. ‘Patients are finding it impossible to book appointments’ due to ‘12 years of Conservative mismanagement’.

Catherine West, Labour MP for Hornsey and Wood Green, asserted that patients who cannot see a GP will instead go to A&E. Streeting stated that patients were waiting because ‘Conservative Governments have cut 4,500 GPs over the last decade, they have closed 300 practices since the last election and they have failed to provide any meaningful reform of the system’.

For Labour, the future of primary care ‘has to be different courses for different horses’: ‘people should have a right to see their GP when they want to’, but access can be more flexible in the form of video or phone consultations. Streeting noted that ‘primary care is entirely unequal’, with some areas having twice as many doctors as others.

Clive Efford, Labour MP for Eltham, said that ‘there is now a value to GP patients lists’ which ‘are collected by GPs, free of charge, [and then] sold to the private sector’.

Later in the debate, Streeting suggested that GP appointments should be able to be booked on the NHS app as ‘patients should not have to wake up at 8 in the morning and wait on the phone for an hour’. He went on to suggest changes to pension rules to retain more GPs and to find places for 800 medicine graduates ‘who had not been able to find posts’. Labour would also recruit 8,500 new mental health professionals to take the responsibility of seeing mental health patients from GPs.

In his response, the Secretary of State Sajid Javid said that he is working with the Home Office to help retain international medical graduates, and is seeking to expand the role of pharmacists.

On 14 June Sajid Javid, the Secretary of State for Health and Social Care, took questions in the House of Commons. Notable questions are summarised here.

Also on 14 June, the Health and Social Care Committee held an oral evidence session for their inquiry into the future of General Practice. The committee heard from:

  • Beccy Baird, Senior Policy Fellow at The King’s Fund
  • Sir Robert Francis QC, Chair at HealthWatch England
  • Mrs Heather Randle, Professional Lead for Education and Primary Care at Royal College of Nursing
  • Dr Peter Holden, GP Partner at Imperial Road Surgery
  • Dr Margaret Ikpoh, Vice Chair Professional Development at Royal College of General Practitioners
  • Professor Mike Holmes, GP Partner at Haxby Group

Mrs Baird outlined the reasons for expanding primary care teams with non-doctor staff. Doing so improves the ‘totality’ of care patients receive and reduces the burden on GPs, although she cautioned these other professionals were not replacements for GPs. She stated that implementing such a system, when done well, leads to much better care for patients.

Mrs Randle asserted that there was ‘no incentive’ for non-GP health professionals to join a primary care team, with recruitment very challenging. Practice Nurses had said they felt ‘invisible’ despite suffering from the same workload pressures. One way to improve the situation with nurses would be to create career pathways for nurses into general practice, and to provide more support for those switching from hospitals to general practice.

Sir Robert described a decline in the patient satisfaction rate for GPs. Many of the issues reported to HealthWatch are around access, there being difficulty booking face-to-face appointments in particular. Other problems include prescriptions, referrals and registration. He felt that the public wanted continuity of care – for whoever they see ‘to know about them’. They were prepared to accept that a doctor was not always the right person to see, as long as there was someone they could identify as being responsible for coordinating their care.

Sir Robert stated that there was a need for an overall workforce strategy, with all health roles needing more people. He also said that GPs should maintain responsibility for patients after they had been referred elsewhere, and proactively chase up delays.

Committee Member Rosie Cooper, MP for West Lancashire, raised the BBC Panorama investigation into Operose Health, suggesting that such stories made the primary care team model difficult to achieve.
Mrs Randle questioned why GPs in a particular surgery saw their pay increase by 3% while the nurses in the team only received 1.5%. Mrs Baird highlighted that the ARRS is not weighted for deprivation.

Professor Holmes said that the strengths of the GP partner model was the supportive environment, career progression and the ability to innovate. The weaknesses of the model were tied to how it is resourced, with it effected by the shrinking workforce and the rise in workload. The professor stressed that the model can work if properly resourced. He continued by saying he was concerned that abolishing the partner model by 2030 may be the Government’s intention. Dr Ikpoh, also a GP partner, described the ability her position provides her to ‘shape the services’ her practice offers and to be more accountable to her community.

Dr Holden asserted that premises problems ‘hugely’ threatened the partnership model. Practices can’t make ‘sensible business decisions’ as they rely completely on government ‘handouts’. There is no room for extra practice team members.

Dr Ikpoh discussed the barriers faced by international recruits, with newly qualified international GPs receiving letters ‘threatening them with deportation’. She also said that there was ‘strong evidence’ that medicals students were not picking general practice because of the issues that they are seeing while training.

On 13 June, the Government responded to the Health and Social Care Committee’s report on cancer services.

“Faster Diagnosis Non-Specific Symptom pathways are transforming the way that people with symptoms not specific to one cancer, such as weight loss or fatigue, are diagnosed or have cancer ruled out. This gives GPs a much-needed referral route, while speeding up and streamlining the process so that, where needed, people can start treatment sooner.”

“Helping people to understand the signs and symptoms of cancer and encouraging them to act on them remains a core pillar of our strategy to diagnose cancers at an earlier stage. In 2021/22, NHSE/I invested more than ever before in awareness campaigns which included awareness campaigns focused on abdominal and lung cancer symptoms, as well as trialling the new campaign to persuade people to overcome their reluctance to contact their GP.”

“Our case-finding initiatives and public awareness campaigns are paying off – GPs are referring more people for urgent cancer checks than ever before – more than 200,000 every month. A joint campaign with Prostate Cancer UK (PCUK) ran through February and March 2022 with over 550,000 people having used the PCUK risk checker to date – those at high risk are encouraged to see their GP.
Community Diagnostic Centres are expected to provide greater direct access to testing for GPs, which will improve their ability to understand and manage risk and clinical urgency for their patients
The NHS Cancer Programme is focused around six priorities to increase early diagnosis, including improving the efficiency and effectiveness of how GPs refer people into the system and create new routes in so that we spread the net more widely.”

“Through delivery of the Delivery plan for tacking the COVID-19 backlog of elective care and the 2022/23 Priorities and Operational Planning Guidance, the NHS will ensure that 75% of patients who have been urgently referred by their GP for suspected cancer will be diagnosed or have cancer ruled out within 28 days by March 2024.”

“A clear set of actions to improve earlier diagnosis amongst the less survivable cancers will be developed. Raising GP and public awareness of potential symptoms will be part of the solution but given the vague nature of many of these symptoms, and, or the low frequency with which a GP will encounter a case; we will need to find more targeted ways to proactively identify those with the greatest risk.”

On 8 June, the Conservative MP for Hertford and Stortford Julie Marson led a Westminster Hall debate on cancer care for young adults.

Mrs Marson had secured the debate as part of a campaign for ‘Jess’ Law’, named for a cancer victim. This law would state that ‘after the third contact with a GP surgery about a condition or symptom, a case should be elevated for review. After five contacts, it should be red-flagged and set procedures and guidelines should be followed, including a referral to a specialist.’ Based on Jess’ case, the MP asserted that ‘many GPs do not expect to see… a young adult with cancer, and that affects their diagnostic processes and judgment.’

Mrs Marson bemoaned the fact that ‘Jessica was not seen by just one GP at her surgery’ despite the GP contract requiring a named GP to ‘take the lead in ensuring that any primary medical services considered necessary, including appropriate referrals to specialist care and liaison with other health professionals involved in the patient’s care, are co-ordinated and delivered to that patient’. The MP also said it was ‘vital that GPs are required to maintain their continuing professional development through up-to-date training’.

Responding, the Minister for Public Safety and Primary Care, Maria Caulfield, noted that it is ‘not unusual for a GP, or even a GP practice, to see only one or two cases across the lifespan of their service’. The Minister highlighted the roll-out of community diagnostic centres, to which ‘patients with non-specific symptoms that GPs cannot get to the bottom of’ can be referred to. She also affirmed that this ‘is not about blaming GPs’.

On the proposal of ‘Jess’ Law’, the Minister confirmed that ‘it is not beyond the realms of possibility to introduce a system ensuring that, if a young person is seen four times and is still coming back with the same symptoms, that is raised to another level’.

On 7 June, Richard Fuller, Conservative MP for North East Bedfordshire, led a Westminster Hall debate on access to GPs. Although not London, the debate did raise more general issues.

Mr Fuller admonished the, to ‘recognise the irritation’ his constituents felt when trying to ‘see someone in primary care’. The MP noted that this has a ‘significant impact on the morale of staff in GP practices’, as such irritation often ‘spills over into abuse of staff’. Mr Fuller stated that there is no ‘reason for any of us to be abusive towards staff who are trying to do their best’.

The MP asserted that ‘remuneration systems provide insufficient incentives for GP partners to take on additional responsibilities’. He encouraged the Government to ‘show by words, actions and remuneration that they value the additional work that partners take on to enable broader provision of primary care in their local practices’. Mr Fuller argued that ‘the partner model has worked well historically and is the best model for the future’, but ‘there should be substantial changes to how the remuneration systems work’.

Mr Fuller worried that there is ‘a tendency to prioritise bureaucratic target setting and undermine the professionalism, integrity and insight of GPs’. Instead, the Government should recognise that’ GP partners are some of the best qualified people in the country’ and to ‘drive them to little target boxes is demeaning’. The MP asked the Minister to ‘look at the additional roles that GPs took on during covid to relieve pressure on hospitals and see whether the balance and remuneration is still right or whether there needs to be some clarification on those roles?’.

The Minister began her response by stating that she will not ‘pretend everything is rosy’. She then discussed the benefits of cloud-based telephony, saying that the NHS and the Government are working ‘to drive full adoption across the system’. Mrs Caulfield argued that there is no need for a 48-hour appointment model, and practices do not need to ‘stick to it’.

The Minister admitted that some changes to the GP contract being introduced are ‘more popular than others’. The Government are on track to recruit 26,000 more healthcare professionals by 2023-24 in addition to the GPs.

In the final session of its inquiry into the recruitment, training and retention of staff on 7 June, the Health and Social Care Committee took evidence from:

  • Amanda Pritchard, Chief Executive Officer, NHS England
  • Professor Stephen Powis, National Medical Director, NHS England
  • Rt Hon Sajid Javid MP, Secretary of State for Health and Social Care, Department of Health and Social Care

Discussing continuity of care, Professor Powis stated that continuity with the general practice team is as important for patients as continuity with one particular GP. He also mentioned that continuity is not always needed, such as in urgent cases. Mrs Pritchard suggested that the end of the current GP contract would be an opportunity to think about changes that would make continuity easier, but noted that implementing the ‘Integrated Neighbourhood Team’ model can begin now. This implementation would be focused on areas with the greatest deprivation.

Mrs Pritchard announced that a primary care toolkit for Long Covid would be published soon. Professor Powis asserted that flexible working was key to staff retention, and would help workforce issues in general practice.

At the start of the session with the Secretary of State, the committee watched a clip of a GP describing her experience of the job at present from a previous evidence session. In response, Mr Javid acknowledged the pressures on GPs and thanked them for their work. He linked these pressures to problems with retention and an increase in GPs cutting hours. He continued by describing the ‘unacceptable’ abuse GPs have also faced. His solution to these problems was to ‘continue our focus on getting more GPs’ and providing support to existing staff.

The Secretary of State believed that the Government were doing all they could to recruit more GPs, while also attempting to address retention issues. He also accepted an invitation from the Chair of the Committee, Jeremy Hunt, to meet with a GP who is operating a patient list system. Mr Javid committed to ‘listen more’ on the issue.

In response to a question about access to appointments, Mr Javid stated that he wanted more technology to be used in GP surgeries, for example with diagnostics and electronic patient records. Part of the answer would be a greater role for other primary care professionals like pharmacists.
Concluding the session, Mr Javid stressed the importance of ‘modernising’ the NHS’ structures and systems.